Fischler School of Education and Human Services - Emerging Instructional Technologies



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Emerging Instructional Technologies

Please fill out the following form. Fields in RED are required fields. An email response will be sent to the email address that you enter. Thanks.


Center or Program Department:
Contact Person:
Phone:	000-000-0000
E-Mail Address:
By completing the Contact Person and E-Mail boxes, you will be the sole person we contact regarding this lab request. Please coordinate all software installs and hardware requirements with the instructor before completing this form. If the instructor does not have the software, please indicate this in the Special Instructions or Comments section and contact us when it arrives so we can test and install it before class. Once confirmation is issued every effort is made to avoid disruption to students and faculty. However it may be necessary to move a class from an assigned lab to another lab for one or more sessions. Please make sure to fill in all required fields to ensure proper processing.

SECTION A - Lab for Classes
Curse Number and Title:
Instructor:
Phone:
E-Mail:
Days Requested:	You must select a day when your class will be held. Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Number of Sessions:	8 12 16 OTHER
Beginning Date:
Ending Date:
Time(from):
Time(to):
*OR - PLEASE ENTER DAYS BELOW*
Sessions Date(s):

Special Instructions or Comments:

Number of Participants:
A.D.A.(American Disabilities Act)Special needs:
*SECTION B -Equipment for Classes* PC Macintosh Scanner Speakers Microphone Digtal Camara Zip Drive Video Capture Card Others
*SECTION C - Software for Classes* Software - complete for all sections
Software: Version:		CD-ROM (To ensure that your CD's are installed correctly, please submit all CD's no less then 7 days in advance.) Disks HardDrive Installation
Software: Version:		CD-ROM (To ensure that your CD's are installed correctly, please submit all CD's no less then 7 days in advance.) Disks HardDrive Installation
Software: Version:		CD-ROM (To ensure that your CD's are installed correctly, please submit all CD's no less then 7 days in advance.) Disks HardDrive Installation


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